| NPI | 1275078800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH25005) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MI 6401222287) |
| Enumeration Date | 2017-01-06 |
| Last Update Date | 2025-05-30 |